Fallon Medicare Plus Orange (HMO)

by Fallon Health

2026 Medicare Advantage plan available in Massachusetts

Plan ID H9001-038-0

Additional coverage:

RxHearingVisionDental

Medicare Advantage HMO $0 premium 4.0 Overall

Monthly plan premium $0 / mo

Annual deductible $0 / yr

Max out-of-pocket · in-network $7,550 / yr

Drug deductible $400 / yr

4.0 Overall Government Star Rating 2026 · out of 5 stars

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Plan Overview

Fallon Medicare Plus Orange (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Massachusetts and offered by the health insurance company Fallon Health. This plan's network type is HMO, which determines the in-network doctors who accept the plan and whether a referral is needed.

Plan Name Fallon Medicare Plus Orange (HMO)

Insurance Carrier Fallon Health

Plan Type Medicare Advantage Plan With Part D Prescription Drug Coverage

Network Type HMO

Cost Summary

Fallon Medicare Plus Orange (HMO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out-of-pocket cost sharing of $7,550. The most common costs people evaluate when choosing a plan are listed here; a full list of benefit costs is defined below.

Monthly Premium $0 / mo

Health portion of premium $0

Drug portion of premium $0

Annual Deductible $0 / yr

Max Out-of-Pocket · in-network $7,550 / yr

Primary doctor visit $10 copay

Specialist visit $20-$50 copay

ER visit $115 copay

Ambulance $325 copay

Additional Benefits and Coverage

Fallon Medicare Plus Orange (HMO) is a Medicare Advantage plan which includes Medicare Part D prescription drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Fallon Medicare Plus Orange (HMO) includes coverage for hearing, vision, dental.

Part D Prescription Drug Coverage Yes

Dental Yes

Vision Yes

Hearing Yes

Nationwide Coverage No

Other benefits

Fitness benefit Not covered

Over-the-counter drug benefits Not covered

In-home support services Not covered

Home & bathroom safety devices Not covered

Meals for short duration Not covered

Annual physical exams Limited coverage

Telehealth Limited coverage

Medical Benefits

Doctor Services

Primary doctor visit In-network: $10 copay
Out-of-network: $10 copay

Specialist visit In-network: $20-$50 copay
Out-of-network: $20-$50 copay

Tests, labs & imaging

Diagnostic tests & procedures In-network: $0 copay
Out-of-network: $0 copay

Lab services In-network: $0 copay
Out-of-network: $0 copay

Diagnostic radiology services (like MRI) In-network: $350 copay
Out-of-network: $350 copay

Outpatient x-rays In-network: $0 copay
Out-of-network: $0 copay

Emergency care $115 copay

Urgent care $40 copay

Hospital Services

Inpatient hospital coverage Tier 1
$385 per day for days 1-7
$0 per day for days 8-90
$0 per stay

Outpatient hospital coverage In-network: $450 copay
Out-of-network: $450 copay

Skilled nursing facility

Skilled nursing facility Tier 1
$0 per day for days 1-20
$188 per day for days 21-100

Preventive services

Preventive services In-network: $0 copay
Out-of-network: $0 copay

Ambulance

Ground ambulance In-network: $325 copay
Out-of-network: $325 copay

Therapy services

Occupational therapy visit In-network: $20 copay
Out-of-network: $20 copay

Physical therapy & speech & language therapy visit In-network: $20 copay
Out-of-network: $20 copay

Mental health services

Outpatient group therapy with a psychiatrist In-network: $40 copay
Out-of-network: $40 copay

Outpatient individual therapy with a psychiatrist In-network: $40 copay
Out-of-network: $40 copay

Outpatient group therapy visit In-network: $40 copay
Out-of-network: $40 copay

Outpatient individual therapy visit In-network: $40 copay
Out-of-network: $40 copay

Opioid treatment services

Opioid treatment services Covered

Other services

Durable medical equipment (like wheelchairs & oxygen) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Prosthetics (like braces, artificial limbs) In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Diabetes supplies In-network: $0 copay
Out-of-network: $0 copay

Prescription drugs (Part D benefits)

Drug tier standard retail · 1-month supply Initial coverage Catastrophic

Preferred Generic $0.00 copay $0 copay

Generic $7.00 copay $0 copay

Preferred Brand $47.00 copay $0 copay

Non-Preferred Drug 35% coinsurance $0 copay

Specialty Tier 28% coinsurance $0 copay

Part B drugs

Chemotherapy drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Other Part B drugs In-network: 0%-20% coinsurance
Out-of-network: 0%-20% coinsurance

Medicare star rating

Each year the federal government rates Medicare Advantage and Part D plans on a 5-star system covering quality of care, chronic-condition management, member experience, and customer service. For 2026, Fallon Medicare Plus Orange (HMO) earned an overall rating of 4.0 stars — the same as Massachusetts's state average of 4.0 stars.

Rating category This plan State average

Overall star rating ★ 4.0 4.0

Health plan quality

Summary rating of health plan quality ★ 4.0 4.0

Staying healthy: screenings, tests & vaccines ★ 4.0 4.1

Managing chronic (long-term) conditions ★ 4.0 3.5

Member experience with health plan ★ 4.0 3.7

Member complaints & changes in performance ★ 5.0 4.4

Health plan customer service ★ 3.0 4.0

Drug plan quality

Summary rating of drug plan quality ★ 4.0 4.0

Drug plan customer service ★ 4.0 4.3

Member complaints & changes in performance ★ 4.0 4.3

Member experience with the drug plan ★ 4.0 3.4

Drug safety & accuracy of drug pricing ★ 4.0 3.8

Extra Benefits

Hearing

Hearing exam In-network: $0 copay
Out-of-network: $0 copay

Fitting/evaluation Not covered

Hearing aids - prescription In-network: $695-$2645 copay
Out-of-network: $695-$2645 copay

Hearing aids - over the counter Not covered

Preventive dental

Oral exam In-network: $0 copay
Out-of-network: $0 copay

Cleaning In-network: $0 copay
Out-of-network: $0 copay

Fluoride treatment In-network: $0 copay
Out-of-network: $0 copay

Dental x-rays In-network: $0 copay
Out-of-network: $0 copay

Comprehensive dental

Restorative services In-network: $31-$856 copay
Out-of-network: $31-$856 copay

Endodontics In-network: $107-$990 copay
Out-of-network: $107-$990 copay

Periodontics In-network: $80-$953 copay
Out-of-network: $80-$953 copay

Prosthodontics, removable In-network: $37-$865 copay
Out-of-network: $37-$865 copay

Prosthodontics, fixed In-network: $76-$860 copay
Out-of-network: $76-$860 copay

Maxillofacial prosthetics Not covered

Implant services Not covered

Oral and maxillofacial surgery In-network: $77-$667 copay
Out-of-network: $77-$667 copay

Orthodontics Not covered

Adjunctive general services In-network: $39-$157 copay
Out-of-network: $39-$157 copay

Vision

Routine eye exam In-network: $0 copay
Out-of-network: $0 copay

Contact lenses In-network: $0 copay
Out-of-network: $0 copay

Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass frames (only) In-network: $0 copay
Out-of-network: $0 copay

Eyeglass lenses (only) In-network: $0 copay
Out-of-network: $0 copay

Upgrades In-network: $0 copay
Out-of-network: $0 copay

Plan documents & tools

Plan details (carrier site)Provider directory Drug list (formulary)

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